Legal

Does a primary care physician remain legally responsible for a patient after referral? The Delaware Superior Court recently determined the answer to be "No." As with all legal proceedings, however, it is important to discuss context.

Get your black bag ready. House calls could be in your future. While Medicare prepares to roll out the Independence at Home pilot program next year, commercial insurers have been testing variations on the concept for some time, especially to provide care to the sickest of the sick.

Fed up with the hours on the telephone to untangle claims issues with insurers? A new proposed rule could help. It requires insurers to use uniform transmission formats and standardized forms when they seek information or provide claims and coverage information to doctors.

Much of the hoopla has focused on a nearly 30% cut in rates in the proposed update to the physician fee schedule for 2012, even though Congress is likely to intervene to keep the reductions from being so severe. But, a provision calling for review of all of the evaluation and management (E&M) codes is likely to be more significant in the long term for primary care physicians.

Massachusetts badly needs to contain healthcare costs, according to two new state government reports.

Medicare's methods of calculating regional costs are inaccurate and need to be redone, according to a new report from the Institute of Medicine.

A proposed change to the Health Insurance Portability and Accountability Act would give people the right to see who has electronically accessed their protected health information.

The Centers for Medicare and Medicaid Services has extended the deadline to October 1 for implementing e-prescribing standards.

The technology requirements to be recognized as a PCMH now closely mirror those needed to prove "meaningful use" of health information technology under the new healthcare legislation.

As of January 1, over-the-counter medications other than insulin need a prescription to qualify for reimbursement from an employer-sponsored flexible spending account or health reimbursement arrangement.

Some U.S. Senators want an investigation of physician-owned distributorships (POD).

Despite today's uncertain economic climate, two recent, surprising reports show that mergers and acquisitions are on the upswing.

The Centers for Medicare & Medicaid Services (CMS) gave organizations interested in participating in the Pioneer ACO model a little longer to circle their wagons. Responding to concerns from provider organizations that there was insufficient time to assemble internal support and strong applications, CMS extended the deadline for applications to August 19 for those who submitted their letters of application by an extended June 30 deadline.

A new bipartisan proposal attempting to ?save? Medicare would impose a 3-year ban on further cuts to Medicare reimbursement to physicians. Other aspects of the plan make its future questionable, however. The proposal includes political landmines, such as raising the Medicare eligibility age and requiring more out-of-pocket payments from Medicare beneficiaries who can afford them.

Just in case you or your front desk staff had plans to take a vacation this summer, you may want to rethink that. Medicare has rolled out a major advertising campaign to get patients to visit you for an annual wellness visit and free preventive services. Since fewer than 20% of eligible patients used those services in the first half of the year, expect an onslaught of request for appointments.

The controversy may have been focused on the government plan to use mystery shoppers to surreptitiously check how many physician offices were open to Medicare and other public insurance patients. But the bigger problem is acceptance of private insurance by medical practices that have to jump through hoops to get paid, according to a new study.

This special report covers the spectrum of ACO topics of interest to the primary care physician.

Lack of capital, integrated systems and evidence-based treatment protocol data all play into the difficulty of creating an accountable care organization (ACO).The biggest challenge, however, is a personnel issue, and how physicians and hospitals will work together to resolve it.

The U.S. Supreme Court said that a Vermont law prohibiting sale of prescription data to drug companies interfered with the pharmaceutical industry's First Amendment right to market its products. A recent survey suggests that the decision will not come as good news to many physicians who feel as if their privacy is being invaded.

The Patient Protection and Affordable Care Act gives new impetus to form accountable care organizations to better coordinate the care of their patients, especially those with chronic diseases, and to ensure a continuum of care.

Know how to protect patients' information with billing companies.

To many physicians, the current healthcare environment is complex and overwhelming. From accountable care organizations, global capitation, and value-based purchasing to episode payments, episode groupers, and bundled payments, the terminology seems to be addressed to larger organizations than small primary care groups.

Federal pilot programs established to use health information technology to improve patient care and reduce costs are having a hard time meeting the latter goal.

Since the Centers for Medicare and Medicaid Services asked for comments on the much-anticipated regulations for accountable care organizations in late March, the proposed rules have been under constant attack.

The proposed accountable care organization regulations arrived on March 31 and have caused much strife and speculation in the medical and legal communities in recent months.

When patients request copies of their electronic health records from your practice, the clock starts ticking. This Q&A gives you the new information on the minimum information required and how quickly you must provide it. Also find out why you soon may have to inform patients when their health information is viewed.

Location, location, location doesn?t just apply to real estate; it also is a factor in how Medicare calculates payments to your practice. But how accurate and consistent is that process? Not very, according to a recent Institute of Medicine Report. Find out what the IOM recommended and what they?re proposing to improve accuracy.

Likely coming to a state near you: Medical malpractice reform. Why have malpractice case filings dropped more than 45%?nearly 70% in Philadelphia?since two significant rule changes implemented by the Pennsylvania Supreme Court? And what has been the effect of a Texas proposition that put a cap on noneconomic damages in medical malpractice claims?

The Centers for Medicare and Medicaid Services (CMS) wants to publicize data about the care you?re providing as a primary care physician so that consumers and business could compare your cost and quality to other providers. The claims data would be derived from both Medicare and private sector insurers. Find out more while there?s still time to influence the final rule.

The certificate of need process required to open a new medical facility has evolved into an arena where providers complete service-line dominance and market share, according to a new study.